Bonnie's Blog

Why we want babies to crawl

Lately it seems like I hear about one parent a week proudly tell me that her child never crawled and just went straight to walking.  When I hear this, inside I am secretly hoping that their child is fine and doesn't experience any motoric challenges down the road.  In the Occupational Therapy world, it is felt that when an infant crawls on hands and knees they are establishing important foundations for future motor, visual, and learning skills.  Crawling strengthens the trunk, arm, and leg muscles, establishing a foundation for the development of higher level motor skills.

As infants crawl, they visually determine where to go, typically looking back and forth between their hands and their target.  In doing so they develop their near vision, the ability to shift between near and far vision, and further establish eye-hand coordination.  

The weight bearing on open palms is felt to develop the arches of the hand, contribute to separation of the two sides of the hand (skilled and support) and help establish good stability of the thumb joint.  This establishes the foundation for the development of mature pencil grip and ease when writing a few years down the road.  We are seeing record numbers of children who are struggling to hold a pencil correctly, because they lack the motor foundations to do so.

Infants from birth on need to spend part of their day on their stomachs.  Gradually they will develop the neck, back, shoulder muscles to bring their upper bodies off the surface and eventually move into crawling.  Infants who spend most of their time either on their backs or propped in sitting often miss out on this important milestone, as they have missed the months of tummy time preparation that allows them to move smoothly into crawling.

What is Therapeutic Listening (and can it help my child)?

Therapeutic Listening®  combines a sound-based intervention with a sensory diet to impact a child's sensory processing and behavioral organization. Therapeutic Listening can impact sensory modulation, attention, behavior, postural organization, and speech and language difficulties. Therapeutic Listening employs electronically altered compact discs that are used in a home program, providing parents the opportunity to significantly enhance their child's sensory program on a daily basis  Ceck out the  Vital Links website for more detailed information, including a four page parent handout.

At Emerge, we have found that therapy outcomes are improved and the length of time in therapy is often reduced when the child is on a consistant Therapeutic Listening program.  Therapeutic Listening is started during therapy sessions and then if it seems to be a good match for the child, headphones and CD can be loaned for a two week trial.  After that, parents puchase the headphones and join the Emerge Therapeutic Listening library so that they can take advantage of a wide array of CDs.  Each CD provides a somewhat different impact on the nervous system, depending on the style of music and instrumentation.

Case one:  A seven year old boy who had been receiving occupational therapy for four months prior to starting Therapeutic Listening.  Each week his teacher sent home a checklist of negative behaviors this child demonstrated during the school week.  Typically it included 16-18 negative checks.  After one week of therapeutic listening (and without informing the teacher), this child brought home a report with only 3 negative checks.

Case two:  A four year old boy who had severe auditory defensiveness, to the point where he would vomit when a fire drill occured at school.  Additionally he would become so overwhelmed at school, that he would growl at other children and attempt to bite them.  After a few weeks of Therapeutic Listening, he was able to just cover his ears in response to the fire drill and was able to appropriately interact with his classmates.

Summer Travel when your child has a Sensory Processing Disorder, part 2

In the last post, we explored strategies to support your child on vacation if he or she is a sensory seeker, but what if your child is more of a sensory avoider.  Some children have sensitive nervous systems that are easily overwhelmed.  Depending on the child, they may demonstrate sensory defensiveness and/or poor sensory regulation/modulation.  As a result, careful planning is needed to make a vacation successful.

1.  Establish familiar routines. Children with sensory defensiveness benefit from predictability and familiarity.  Establish a routine to the days.  In thinking about the day's activities, less is typically better for this child.  If you are using sensory supports (deep pressure protocol, sensory diet, therapeutic listening, etc,) continue these and ask your child's occupational therapist if any adjustments should be made to the program you are currently implementing.  Pack favorite clothes, soap, shampoo, toothpaste.  Remember sunglasses and hat if your child is sensitive to the sun.

2.  Don't push interactions with relatives.  For many children, visiting is overwhelming people they don't know very well:  people wanting to hug and kiss them or even pick them up; people that may be loud; houses that may smell funny; food that is different from what they are used to, etc.  Let your relatives know what works for you child: let them initiate any physical interaction; establish a safe, quiet place if they need it; bring familiar items to make sleeping (pillow, blanket), play, and eating comfortable.

3.  Plan for down times.  Remember that even when your child is having a good time, it can still be draining on their nervous systems and require some quiet time to recoup.   If touring a busy city, find a quiet place to eat, go back to the hotel room or play in a park for awhile.  Giving a sensitive child time to regroup can help them manage themselves better and reduce/prevent meltdowns. Years ago when I took my seven year old son to Disney World, we went to the park when it opened and stayed until lunch time.  Then we went back to the hotel and pool for the afternoon, returning to the park in late afternoon, making for a much more relaxing experience.

4.  Honor your child's perceptions.  While it can be frustrating to parents, when children react negatively to experiences that are generally perceived as being fun, it is important to recognize that their reacts are based on how their nervous system perceives the experience.  Listen to them and modify your plans.  While it is fine to expose your child to new experiences and gently encourage their participation, be careful not to force your child to engage in an activity that for them is at best uncomfortable and at worse triggers a fight/flight/fright/freeze response.  For some children, the beach is overwhelming:  the sand; splashing, cold, salty water; hot sun; lots of people.  For some children, movement is frightening: going on rides, esp. roller coasters is the last thing they want to do.

Vacationing with your child who has a sensory processing disorder can be challenging, but with careful planning and a little accommodation, the vacation can be a wonderful experience for the entire family.

Summer Travel when your child has a Sensory Processing Disorder, part 1

Often taking children out of their home and familiar routines can often be challenging.  When you plan your summer vacation, think about your child's sensory needs and how they respond to different environments.  Every child's needs are different and we often tell parents they need to be detectives to discover what works best for their child.

The sensory seeker:  Chances are this child will love vacation, especially if their are lots of opportunities for physical activity.  We see many children who thrive at the beach.  Walking/running on the beach, digging in the sand, playing in the water, being knocked over by waves, etc. often provides an intensive sensory diet that is hard to match back at home.  These same children also often love amusement parks, especially if they seek vestibular input: the various rides, including roller coasters, again provide intensive sensory input opportunities. 

The challenge is to provide transition activities at the end of the day to help your child make a smooth transition from a stimulating environment back to the hotel, cottage or grandma's house.  Move to activities that are somewhat less stimulating at the end of the day; building a sand castle, riding a train or other less stimulating ride.  Have your child wear a backpack with 5 - 10% of his or her body weight on the walk back to the car.  Provide a snack at the car including something crunchy or chewy and a drink with a straw.  If your child is doing a Theraputic Listening program, this may be a good time to use it.  Ask your therapist for a suggestion about a good CD for this transition.  Provide a fidget (e.g. squeeze ball, theraputty, etc.) for the ride.

The more challenging situations for the Sensory Seeker are when they need to be still:  airplane rides, long car rides, etc.  Be sure to 'pre-load' your child's nervous system by engaging them in physical activity before asking them to sit still.  If traveling by car, stop every 1-2 hours at a roadside park for a movement break.  Have a ball, frisbee, theraband, etc. ready to facilitate active play.  When they need to sit, provide activities for their hands (think heavy work: play dough/clay, pop beads, hole puncher) and something for their mouths (gum, star bursts, fruit leather, bagels, jerky, water bottle with straw).

And even though children who are Sensory Seekers tend to like a lot of activity, all children can become overloaded.  Don't pack every day with activities, especially if you are seeing lots of relatives or are spending the week at Walt Disney (or similar).  Build in some times that are less stimulating, allowing your child time to regroup.

 

Art Supplies

I wanted to share the Stubby Pencil Studio, a great on-line resource for eco friendly drawing and art supplies.  They carry Crayon Rocks which we use in the office and have often recommended to parents for home use.  The unique shape of the crayons promotes a mature pencil grasp.  They have a variety of triangular shaped pencils which also help promote a mature pencil grip, including Jumbo Triangular Color EcoPencils, which at just 5" long, fit well into small hands.  I also like their Color 'n Kids cards that offer a simple design with a word to trace.  A great way to encourage your child to make their own thank-you or other greeting cards.

Practical Fine Motor Activities

Recently I was at a school IEP meeting for a child evaluated at Emerge.  I suggested that one of his OT goals might be competency in functional fine motor activities and gave a couple of examples.  The school OT was happy to work on such activities, but asked for a list of suggestions.  The result is the list below.  These are practical, functional skills that allow children to be successful with everyday tasks.  It is geared towards elementary aged students, with some items, such as shuffling cards, more appropriate for those children at least in the third grade.   Make a copy of the list.  Summer is a great time for your child to learn some new skills.

•    Wrapping a rubber band twice around a deck of cards.
•    Shuffling cards.
•    Rolling up art work or poster and placing a rubber band around it.
•    Tearing tape off of a tape dispenser.
•    Wrapping a small present.
•    Repairing a broken game box, neatly taping corners.
•    Using a ruler to measure.
•    Tearing perforated pages out of a workbook or spiral notebook.
•    Dressing a Barbie, Bratz or GI Joe doll.
•    Unwrapping a CD.
•    Loading coins into a paper coin sleeve.
•    Stapling papers together.
•    Removing staples using staple remover.
•    Using a hole punch in a targeted location.
•    Using a paper brad.
•    Paper clipping papers together.
•    Sharpening pencils with a manual pencil sharpener.
•    Opening three ring binder, placing papers, then closing binder.
•    Threading a needle.
•    Sewing on a button.
•    Using a potato peeler to peel a carrot or potato.
•    Untying shoes that have been double knotted.
•    Neatly (and appropriately) folding paper and putting into envelopes.
         Quarter-fold for small envelopes
         One-third fold for legal envelopes

Ideation and the case for unstructured play/toys

Ideation is described as the first stage of motor planning.  It is the ability to generate an idea of how one might interact with an object or the environment. The "what am I going to do?".  Children with poor ideation skills generally have very limited play skills and are often dependent on adult intervention and passive pursuits (TV, Videos, computer, video games).  They may wander the room briefly picking up objects, manipulate the object, but literally have no ideas how to play with it.  Parents tell me that their child will watch them play with the toys, but seem at a loss when left on their own.  Parents say:  'He has so many toys, but doesn't really play with any of them.'  Older children demonstrate poor problem solving skills. Ideation is a cognitive process believed to be largely dependent upon the brain's ability to respond properly to sensory input.

I have an 11 month old grandson and recently had the opportunity to observe his ideation with two rather non-descript items.  The first was an 8" square of stiff plastic.  For 30 minutes, he played with this piece of plastic.  He crumpled it to make noise; he looked through it; he put it on top of his head; he laid on his back and used both his hands and feet to play with it; he put it on top of his head; he dropped it over his head and then turned around to see where it had landed; he waved it up and down.  This piece of plastic entertained him far longer than any of his toys ever had. 

We had a similar experience at the Museum of Life and Science.  They currently have a large room with multiple stations for building with Kapla Blocks.  Five bins with blocks were lined up on the floor.  He crawled through the five bins (on top of the blocks).  He sat in a bin at one end.  He picked up blocks and put them on the floor and into the bin he was sitting in.  He banged two blocks together.  He handed them to me. He tried to hold several at one time.  He moved to the middle bin.  He transferred blocks from the bin to his left side to the bin on his right side.  He wiggled his feet in the blocks.  He leaned backwards, seeing how far backward he could go. He scouted up and sat on the edge of the bin.

For me it was a great lesson in how early ideation develops.  And a reaffirmation that the best toys are often the simplest.  So take a look at your child's play.  Challenge them.  What can they do if you reduce the quantity of their toys.  Children today tend to be inundated with toys and the overwhelming quantity can squelch ideation, creativity and play.  Consider only having 10 toys available at any given time (pack the others away and create a rotating schedule for bringing them out).  By the way, blocks count as one toy.

Make sure that your child has some of the classic toys, popular before the age of electronics and computers.  Blocks, legos, card board boxes, ball, doll with clothes, wagon, cards, sand, water, play dough, etc.  Make sure your child has the time and space to develop these play skills.  If they are 'bored', a little boredom is just fine, that's where creativity springs from.  If they are struggling, sit and play with them, modeling, prompting.  If they are really stuck they probably need occupational therapy and the therapist working with your child can help with strategies for developing ideation. 

Interactive Metronome

Summer is a great time to undertake an Interactive Metronome® (IM) program for your child.  IM is a neuro-motor assessment & treatment tool used in therapy to improve the neurological processes of motor planning,sequencing, rhythm and timing. IM ‘trains the brain’ to plan, sequence and process information more effectively through repetition of interactive exercises.

The IM program provides a structured, goal-oriented process that challenges the child to synchronize a range of hand and foot exercises to a precise computer-generated reference tone heard through headphones. The child attempts to match the rhythmic beat with repetitive motor actions. An auditory-visual guidance system provides immediate feedback measured in milliseconds, and a score is provided.

The IM program has been shown to produce significant results in children and adults with a wide range of physical and cognitive difficulties including ADHD. The March/April 2001 issue of the American Journal of Occupational Therapy identified five core areas of statistically significant improvements gained through the IM training program:

• Attention and Focus
• Motor Control and Coordination
• Language Processing
• Reading and Math Fluency
• Ability to Regulate Aggression / Impulsivity

Ongoing studies continue to validate correlations between Interactive Metronome and academic achievement in mathematics, language, reading and attention to task. The IM program has also proven to be a powerful tool for improving both the physical and mental aspects of athletic and musical performance.  IM is useful not only with children (or adults) experiencing specific attention, learning or motor challenges, but also as a tool for improving skills in typically developing children. 

An occupational therapist on our national list serve shared this experience with Interactive Metronome: "I have had two students who had Interactive Metronome through a private occupational therapy clinic; both are first graders. The mother of the boy said it "turned her son's life around", and he is doing much better academically. The teacher of the girl is seeing academic improvement, as well as the ability to sit and focus for longer periods of time. I also work with a PT whose daughter was having difficulty with motor
skills, and struggling academically. She completed a course of IM and now works at grade level, and began ice skating during the winter."

While Emerge offers this program year-round, the summer is often the best time to do it, due to the program's intensity.  It is typically a 15 session program completed over the course of 5 weeks.  While it can sometimes be adapted for use with younger children, it is typically used with children aged 7 and above.  If you are interested in exploring Interactive Metronome as an option for your child, please call Michelle @ 489-7333.

String Along Lacing Kit

If you are looking for a fun toy that develops fine motor and visual perceptual skills, consider the String Along Lacing Kit.  We have used it with children as young as three and up to 8 or 9 (although frankly it is fun at any age).  A colored string is loaded into the punch needle and then pushed into a hole on the board.  The inset foam holds the string in place as the needle is moved to a new hole.  As the string is connected from hole to hole, a picture is created. Holding the 'needle' is a great way to reinforce the correct way to hold a pencil, while doing a fun and engaging activity. While the basic kit can be used by children as young as three, the pattern cards provide extra visual perceptual challenge for older children. The String-Along kit is fun, quiet, and portable, making it a great travel activity. The board stands up well to being used multiple times.  Designs are removed quickly and easily just by pulling one end of the string.

Food School

Are you frustrated by your child's limited food repertoire?

Do you want your child to eat a more varied, healthy diet?

Emerge can help!

In addition to our preschool program, Emerge is very excited to offer FOOD SCHOOL.  In Food School therapists work with small groups of children, ages 5 year olds and up using the Toomey SOS (Sensory-Oral-Sequential) Approach in order to:

• expand a child’s food repertoire,
• develop socially acceptable behaviors around food,
• correct sensory misperceptions and damaging self-esteem issues related to food.

The focus of these groups will be to use kid-friendly “scientific approach” to “exploring food”. Children will learn to engage with and explore food in a comfortable and sensory supportive environment. The groups will also incorporate “lessons” to facilitate a child’s understanding of nutrition and the process of eating (both anatomical and physiological).

Please check with your child's therapist or call 489-7333 if you would like more information or want to register your child.  new preschool and school age groups will be starting on June 16th.